(inq into obesity) australian
TRANSCRIPT
australian
Submission No. 103(Inq into Obesity)
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June 2008
Australian Nursing Federation
Level 1, 365 Queen Street
Melbourne VIC 3000
T: 03 9602 8500
F; 03 9602 8567
http://www.anf.org.au
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1. Introduction
The Australian Nursing Federation (ANF), established in 1924, is the national
union for nurses with branches in each state and territory of Australia. The ANF is
aiso the largest professional nursing organisation in Australia. The ANF's core
business is the industrial and professional representation of nurses and nursing.
The ANF's 160,000 members are employed in a wide range of enterprises in
urban, rural and remote locations in the public, private and aged care sectors,
including hospitals, health services, schools, universities, the armed forces,
statutory authorities, local government, offshore territories and industries.
The ANF participates in the development of policy in nursing, nursing regulation,
health, community services, veteran's affairs, education, training, occupational
health and safety, industrial relations, immigration and law reform.
Nurses are the largest health professional group providing health care to the
population of Australia. According to the Australian Institute of Health and Welfare
(AIHW) Nursing and Midwifery Labour Force Survey (2005) there are 285,619
nurses in Australia, comprising 230,578 registered nurses and 55,042 enrolled
nurses. Nurses constitute more than 54% of the health workforce. In excess of
40,000 of these licensed qualified nurses are currently choosing not to work as
nurses1.
2. The role of primary health care in obesity prevention
Action to prevent obesity is much more effective than treatment of obesity and all
its related diseases.
A considerable number of nurses work in a primary health care setting and are
employed as maternal and child health nurses, general practice nurses,
school nurses, community health nurses, occupational health nurses, nurse
practitioners and rural & remote nurses. The combination of an international
health workforce shortage, an ageing nursing workforce and an ageing population
requires a shift in our approach to health care in Australia. Primary health care is
a key component of the health reform necessary to address these issues facing
the Australian population. An opportunity for employment in a primary health care
setting with an emphasis on health promotion and illness prevention may attract
some of the licensed qualified nurses currently not practising as nurses back to
the workforce.
Primary health care acknowledges a social view of health and promotes the
concept of self reliance to individuals and communities in exercising control over
conditions which determine their health. Primary health care is both an approach
to dealing with health issues and a level of service provision.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Health ao.d Ageing Inquiry into Obesity in Australia •• jane 2008
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As an approach, primary health care deals with the main health problems and
issues experienced by the Australian community, and may include care and
treatment services, rehabilitation and support for individuals or families, health
promotion and illness prevention and community development2.
The Declaration of the Alma Ata defines primary health care as the first level of
contact of individuals, the family, and community, with the national health system,
bringing health care as close as possible to where people live and work and
constitutes the first element of a continuing health care process3.
Inherent to primary health care is the promotion and understanding of health as a
complete state of physical, social and emotional well-being, not merely the
absence of disease.
Previous strategies to address the issue of obesity in Australia have focused on
the most effective types of interventions such as diet and exercise rather than on
who the primary health care providers are and how they can most effectively
engage in interventions to ensure long term results.
There is increasing evidence of the effectiveness of nurse-led care in primary
health care settings. Nurses provide effective care, with positive health outcomes,
and nurse-led care has high levels of patient satisfaction and quality of life4.
Building on nursing capacity to deliver primary health care across a variety of
settings, and further investing in these nursing roles will enhance the positive
outcomes that evidence already indicates can be achieved.
3. Increasing prevalence of obesity in the Australian population
Australia has one of the highest proportions of overweight children in the
developed world and this is steadily increasing. Being overweight at six years is
a strong indicator for being overweight in adulthood, yet few interventions focus
on young children6. Just over half of al! Australians aged 15 years and over are
overweight or obese6. Developing healthy behaviours in childhood is an
important step in limiting adult obesity.
Interventions that do focus on children are aimed mostly at school aged children,
whose food preferences and lifestyles are already likely to be well established.
Parents' roles in developing children's attitudes and habits regarding diet and
exercise is critical. Strategies that focus on shared goals between primary hearth
care providers and parents are essential for long term success7. Currently,
schools and primary health care settings do not provide the services needed for
lasting behavioural change. Although population health strategies in both schools
and communities are vital, their effectiveness, reach and sustainability must be
improved to reduce the prevalence of obesity in Australia.
Australian Nursing FederationSubmission to the House; of Representatives Standing Committee on Health and Ageing Inquiry into Obesity in Australia •• June 2.008
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4. Future impiications for Australia's health system
Childhood obesity has serious consequences for children's health and wellbeing.
These include: health disorders (including those previously only seen in adults,
such as type 2 diabetes and heart disease); emotional and social problems
(including teasing, bullying, low self-esteem, poor body image, eating disorders
and depression); adult obesity (there are close links between adult overweight or
obesity and obesity in childhood); and physical health problems in adulthood
(including cardiovascular disease, type 2 diabetes, cancer, infertility and skin
disorders). If obesity has existed since childhood, associated illnesses and health
problems are more likely to occur in adulthood8.
The Federal Health Minister, Nicola Roxon, has acknowledged that obesity is a
major health challenge with in excess of 3 million Australians currently obese and
that figure expected to exceed 7 million by 20259. According to Access Economics,
the estimated total cost of obesity in Australia is $21 billion each year10.
These are compelling social and economic arguments to illustrate the urgent
need to address the growing incidence of obesity in Australia, to minimise the
burden this places on the health of the population.
5. Prevention and management of obesity in children, youthand adults
There are currently in excess of 27,000 nurses employed in a variety of roles
providing health care to the Australian community within a primary health care
setting. Nurses choosing to work in this setting include: maternal and child health
nurses; practice nurses; secondary school nurses; community health nurses;
occupational health nurses; and nurse practitioners.
These nurses are well placed to facilitate new ways of working, which is pivotal in
effecting the rapid sustained change necessary to address the public health issue
of obesity in Australia.
5.1 Maternal and child health nurses
Maternal and child health nurses are registered nurses, and in many instances
midwives, with additional qualifications in maternal and child health and
community health. These nurses offer a range of services in their practice through
individual consultations, home visits and group meetings. They offer support and
guidance to families to develop parenting skills; assess child growth,
development and behaviour at key ages and stages; guide and inform families in
relation to family health, breastfeeding, immunisations, nutrition, accident
prevention and child behaviour; provide access to information on child and
family services.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Health and Ageing Inquiry into Obesity in Australia • June 2008
According to the World Health Organisation, breastfeeding protects against many
chronic childhood conditions, such as allergies, type 1 diabetes, asthma,
ulcerative colitis and Croon's disease. It is also associated with lower risk factors
for cardiovascular diseases including high blood pressure and obesity11.
There are 5,276 registered nurses working in the area of family and child health.
The majority are employed in New South Wales, Victoria and Queensland12.
Maternal and child health nurses are well equipped to provide health education to
families, promoting the diet and lifestyle necessary to prevent the occurrence of
obesity. Encouragement and support should be given to registered nurses and
rnidwives to gain qualification and authorisation as maternal and child health
nurses. There needs to be an extension of the existing service that can be
provided by these advanced practice nurses which can be achieved by
increasing their number and geographical distribution.
5.2 Practice nurses
Practice nurses are registered nurses or enrolled nurses employed by, or
otherwise retained by, a general practice. As at December 2005 almost 5000
practice nurses were estimated to be employed in general practice and more than
half (57%) of general practices were reported to employ a practice nurse.
Anecdotally, that figure has now risen considerably, to around 8,000 nurses in 200713.
As part of its election commitments on health, the Australian Government
announced the introduction of a Healthy Kids Check for ail children starting
school. The purpose of the Healthy Kids Check is to ensure that every Australian
four year old child has a basic health check to see if they are healthy, fit and ready
to learn when they start school. The Government has committed up to $35 million
over four years for the development of a Medicare Healthy Kids Check item and
block funding to other immunisation providers. About 250,000 children wilt be
eligible to receive the health check. Funding will also be provided to produce a
Healthy Habits for Life guide for parents. The Healthy Kids Check can be
provided by a practice nurse or a general practitioner.
This initiative will enable practice nurses to identify possible diet and lifestyle
issues which contribute to obesity and provide the necessary health education for
the whole family. Where appropriate, identified children and their families should
be able to receive Medicare funded follow up with their practice nurse to monitor
the effectiveness of education and develop ongoing strategies to address the
issue of obesity which left untreated will lead to other health-related conditions.
Practice nurses can undertake motivational interviewing and brief,
solution-focused sessions with families and are able to discuss potentially
sensitive issues with parents.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Heaith and Ageing inquiry into Obesity in Australia - .km? 2008
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Improving the capacity of primary health care to respond to the changing service
demands can be achieved by making more use of the services of the current
workforce of practice nurses. Practice nurses are increasingly being called upon
to undertake a greater range of functions in general practice which contribute to
the delivery of better quality and safer care.
Practice nurses are autonomous health professionals, accountable and
responsible for the care that they provide. Acknowledging this will go some way
to fully utilising the capacity of current practice nurses in the general practice
setting. Practice nurses should be able to assess and initiate care according to
their clients care needs within their scope of nursing practice, with direct access
to the Medicare funding rebate. Introducing strategies to encourage qualified
licensed nurses currently choosing not to be employed as a nurse to consider
working in a primary health care setting is also essential to increasing the
number and subsequent capacity of practice nurses.
5.3 Primary school nurses
School nurses provide a primary health care service to primary school aged
children (5-12 years of age) and their families. Primary health care includes a
range of services directed towards health promotion and information, early
identification and intervention for health concerns. School nurses engage in
clinical care, health counselling, health promotion, school community
development activities, networking/resource and referral and general health
centre management.
An example of an effective model for school nurses is that of the Primary School
Nursing Program in Victoria which employs 75.8 effective full time registered
nurses to provide services to approximately 1750 state, catholic and independent
primary schools. The focus of the Primary School Nursing Program is to provide
specific health surveillance activities for children at school entry as part of a
network of health and support services available to families within a local
community. A health assessment is offered to all school entrant students and
other students in any grade where a parent, teacher or nurse has a concern. In
addition to vision screening and hearing testing, health promotion and education
activities are undertaken through both specific activities (eg. group sessions) and
opportunistically through daily contact with students, teachers or parents in line
with program goals including immunisation, safety and injury prevention, nutrition,
positive parenting and asthma management14.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Health and Ageing inquiry into Obesity in Australia - June 2008
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The Program goes some way towards providing health assessments for primary
school aged children, but would need to be further expanded to offer the
education needed to prevent and manage the obesity epidemic in children. A
national expansion of this model whereby a primary school nurse is employed by
the school or a number of schools to provide a full suite of primary health care
services would serve to address many of the health and diet related issues
facing primary school aged children and their families. These issues currently fall to
teachers who, in many instances, feel ill equipped to manage them appropriately.
5.4 Secondary school nurses
Linking health care with education is essential to support young people to care for
themselves, make healthy lifestyle choices and modify behaviour in order to
maximize the opportunities school provides.
Secondary school nurses have a key role in reducing negative health outcomes
and risk taking behaviours by young people, including drug and alcohol abuse,
smoking, eating disorders, obesity, depression, suicide and injuries. The role
specifically encompasses: individual health counselling; health promotion and
planning; school community development activities; small group work focusing on
health related discussion and information; and a resource and referral service to
assist young people to make healthy life style choices.
Again, an example of this in practice can be seen in Victoria where the Victorian
State Government has employed secondary school nurses to reduce risk to
young people and promote better health in the wider community. The program
employs 100 nurses in 199 government secondary schools across the state. The
nurses are based in two schools each and are employed through the Department
of Human Services with a major role in health promotion and primary prevention.
The role of the secondary school nurse is to build on initiatives that have already
been developed in schools and provide appropriate preventative health care,
which addresses the sensitive and complex nature of health issues for young
people, their families and school community15.
Expansion of this secondary school nurse model to other states and territories
could seek to address many of the issues facing young people relating to healthy
lifestyle choices and associated behaviour modification, including but not limited
to prevention and management of obesity.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Neaith and Ageing Inquiry into Obesity in Australia - June 2008
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5.5 Community health nurses
Community health nursing is a unique model combining generalist nursing
practice, public health, health promotion and primary health care. Community
health nurses work with local communities to prevent illness and promote health
across the lifespan. Community health nurses identify and challenge barriers to
wellness and empower people to change the habits that effect their health
adversely. By working in partnership with families and communities, community
health nurses seek to foster a sense of self-determination and empowerment of
clients and can provide valuable service to improve population health outcomes.
The AIHW survey indicates that there are 13,928 nurses employed in the area of
community health16, which may include those employed as school nurses and
occupational health nurses. As is the case for practice nurses, better use of the
current workforce of community health nurses will improve the capacity of primary
health care to address the issues of health promotion and illness prevention in a
changing health care environment. Introducing strategies to encourage qualified
licensed nurses currently choosing not to be employed as a nurse to consider
working in primary health care setting is also essential to increasing the number
and subsequent capacity of community health nurses.
5.6 Occupational health nurses
Occupational health nurses provide health and safety programs and services to
workers and community groups. This area of nursing practice focuses on
promotion and restoration of health, prevention of illness and injury and
protection from work related and environmental hazards.
The occupational health nurse has an integral role in facilitating and promoting an
organisation's on site occupational health program. Their scope of practice
includes disease management, environmental health, emergency preparedness
and disaster planning in response to natural, technological and human hazards to
work and community environments.
Ensuring a safe and hazard free workplace through the provision of specialist
health and safety advice and administering injury management, first aid and
emergency preparedness programs are key functions of this role.
The role of the occupational health nurse includes but is not limited to: case
management; counselling and crisis intervention; health promotion; legal and
regulatory compliance; worker and workplace hazard detection and business
leadership.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Health and Ageing inquiry into Obesity in Australia - Mine 2008
Occupational health nurses develop programs and provide health education to
encourage workers to take responsibility for their own health. Exercise and
fitness, nutrition and weight control, stress management, smoking cessation,
management of chronic illnesses and effective use of health services are some of
the preventative strategies/programs that these nurses use to assist workers to
be healthy and productive.
Poor employee health comes at a high financial cost to organisations.
Occupational health nurses can assist organisations to maximise employee
productivity and reduce costs with less workplace injuries, reductions in disability
claims and improved rates of absenteeism17.
Educating employees about how to stay healthy in the workplace is a huge
challenge. Occupational health nurses are in a position to implement lifestyle and
behaviour change programs to workplaces using their unique skill set and the
best available evidence.
5.7 Nurse practitioners
Nurse practitioners are registered nurses with the education and extensive
experience required to perform in an advanced clinical role. A nurse practitioner's
scope of practice extends beyond that of the registered nurse.
There are approximately 250 nurse practitioners in Australia18. Nurse
practitioners are widely accepted by the community as members of the health
care team in all geographical settings. Nurse practitioners offer health services in
a range of specialties and locations and provide high quality health care resulting
in positive patient outcomes.
A nurse practitioner offers a range of health care services including initiation of
diagnostic tests, prescribing of medication and the authority to make referrals to
other health professionals. Nurse practitioners provide pivotal service delivery in
all communities:
Nurse practitioners are ideally placed to deliver primary health care. This is not
about replacing doctors but rather providing a service that is currently
unavailable. The role of the nurse practitioner working within the multidiscipfinary
team includes "extended practice in the autonomous assessment and
management of clients, using nursing knowledge and skills gained through
post-graduate education and clinical experience in a specific area of nursing"19.
The scope of practice of the nurse practitioner is determined by the context in
which the nurse practitioner is authorised to practice. Nurse practitioners may be
employed and authorised to practice in any of the primary health care roles
outlined above.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Health and Ageing inquiry into Obesity in Australia - June 2008
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6. Summary
Health workforce shortages persist in Australia. These shortages, combined with
an ageing population and a greater incidence of chronic disease have meant that
there is an increasing need to rethink ways in which health care can be delivered
more effectively and efficiently.
Primary health care can and should be offered by advanced practice nurses and
nurse practitioners functioning both in isolated roles and autonomously as
, members of the rnultidisciplinary team in the provision of health promotion and
wellness programs, health assessments and obesity related disease
management programs.
To achieve an improvement in health outcomes and a reduction in obesity the
primary health care nursing workforce needs to be expanded both in scope and
number to address the health education and promotion needs of the Australian
population. This expansion can be achieved with Australian Government
incentives to employ nurses in a variety of primary health care settings including
but not limited to maternal and child health centres, kindergartens, child care
centres, schools, general practices, community health settings and workplaces;
further expansion of existing primary health care programs {ie: school nurse
programs); paid nursing refresher/re-entry to primary health care practice
programs; and scholarships for nursing post-graduate qualifications in primary
health care.
Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Health and Ageing Inquiry into Obesity in Australia - June 2008
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Australian Nursing FederationSubmission to the House of Representatives Standing Committee on Health and Ageing Inquiry into Obesity in Australia - June 2008